My Story About Health Care Reform

I haven’t said a whole lot about the health care reform debate but I think we need a change.

A few years ago I was at a presentation by Newt Gingrich when he said we needed to just throw out the system and start over – we didn’t need reform, we needed something completely new. I agreed with him then. I agree with him now.

I’m not smart enough to figure out what that should look like. But I am smart enough to look at the stats from countries with socialized medicine and see that they live longer than we do, which seems counter-intuitive to the idea that they don’t get access to medical care. In reality, they get far more access than many Americans do.

As is so often the case with any such discussion in this country, it’s WHICH Americans are getting care that is the issue. Those who have private insurance have great access to care. Those who don’t have private insurance have very little access to care. Oh sure, you can go to the emergency room, but stats show people are reluctant to do that until the situation is very serious and they’re far more likely to die.

It’s the haves and have-nots. Most of the haves can’t see why we need to change a thing. They’ve got insurance and therefore access to health care. They don’t want it messed with. They believe that, obviously, everyone else could have it too if they were making good decisions/living right/working hard/fill in the phrase of your choice.

I’ve been a very lucky girl because I’ve always been in the “have it” category. And, yet, because of a need for surgery earlier this year I send hundreds of dollars a month to various medical entities. I say “no” to many things I’d like to do because I need to pay medical bills. I say “no” to luxuries like concerts, events, weekend trips, dinners out and dozens of other things because I need the money to pay medical bills.

I work as much as I can outside of my “normal” job to make extra money to pay medical bills. I’m really blessed I’m able to do that – that I have skills I can market, that people are willing to pay me for them and that my job allows me to use my time off to do those sorts of things.

In between I take phone calls from medical entities whose default mode is “nasty,” for no reason other than they can be, I suppose. I’ve been in tears more times than I can count. I’ve been able to set up payment plans with everyone and I’ve not been late a single time, but the default if I need to talk to them about something is usually nasty and condescending. For those who have treated me like a normal human being, who just didn’t happen to have a few thousand dollars on hand to give you immediately, I thank you. You don’t know how much your kindnesses have meant to me.

I worry every day about medical bills. Every day. If I’m being treated this way and I have insurance and am paying my bills I cannot imagine what it’s like to have no insurance and a bill that’s many tens of thousands of dollars more than mine. Because, of course, my bill was reduced significantly by the “negotiated” insurance rate.

This is just another scam of the health care system. If the negotiated rate is $100 for something, you can’t make me believe anyone is losing money on it. In one case, a friend’s $11,000 bill became less than $1000 at the negotiated rate. But, of course, if you don’t have insurance, it costs $11,000. And when you can’t pay it, it’s written off as a “loss.” In reality, the loss was less than $1,000 because everyone is still making a profit at that. But the loss is entered as $11,000 and bandied about as evidence of how awful it is that they’re having to absorb these horrendous bills.

The reason I have so many bills is that I had an insurance with a high deductible – not because I was trying to save so much money on premiums, but because it was all I could afford. And it wasn’t easy for me to get that insurance card. Because I’m overweight I was deemed as uninsurable by the insurance companies. My cholesterol is 107. My sugar is normal. My blood pressure is normal. But it didn’t matter. I didn’t fit on their charts and they were having none of me. Because we have an option in Kansas for a “public” system you can buy into, I had insurance. I was paying about $275 a month in premiums for a $7500 deductible. I would have liked a lower deductible, but the next level at a $5000 deductible was just more than I could afford. But, thankfully, I had insurance.

When I was diagnosed with an ovarian tumor in January, my insurance card bought me access to a specialist without me having to lift a finger, other than to pull the card out. That magic card gave me passage from my doctor to a surgeon to a specialist, all within a few days. And I’m grateful. I thought as I went under that morning, not knowing if I would wake up as a “cancer patient” or as “very lucky girl,” that I was getting the best care I could. Why? Because I had an insurance card.

So, here I am, a very lucky girl. And I know it. And I’m thankful. My tumor was benign. My surgeon was fantastic. My hospital was exceptional. My friends were terrific. I’m a very lucky girl.

But, although I’m a “have” in the insurance game, and a very lucky girl, I am not willing to gamble that I will always be so lucky as to be a “have.” And I’m not so heartless to think that because I “have,” that’s all that matters. I want everyone to be a have. And I’m willing to pay more taxes for it. Yes, that’s right. I’m willing to pay more taxes. I do not believe I will be paying as much in taxes as I’m paying now for insurance and care. I also just do not believe myself to be so special that I should be a “have” while others do without. I don’t think I’m that much more intelligent or hard working or entitled than others who don’t have insurance.

Because I’ve had to go find insurance, and have actually gone through that process, I have some sense of just how tenuous it is. I’ve also sat on a board of directors where we were hearing repeatedly how upset people were that they weren’t getting raises while we were continuing to pay their insurance premiums that had doubled in just a few short years. I suggested at one time that we stop offering insurance and give people the money instead. That was not viewed as a viable option. But at some point it will have to be because companies just will not be able to afford to continue offering insurance.

If people didn’t get insurance through their companies – which frankly makes no real sense, it’s just something that evolved over time – a huge percentage of people would not be able to get it. If you’re a little bit overweight, have high blood pressure or diabetes, have had cancer or a heart attack, have severe allergies or a congenital defect, or any number of other “common” ailments like high cholesterol you are probably uninsurable.

Respectfully, if you haven’t ever had to go find insurance on your own, you can’t really speak to what the insurance crisis is like. If you actually need insurance, or if you fit on their chart where they think you might need insurance, they aren’t interested in having you as a customer.

Now I work somewhere where insurance is an option and all I had to do was fill out a sheet of paper and sign it. I pay half and they pay half. I’m paying about what I was but my deductible is 10% of what it was. Of course, absolutely nothing has changed about my health status. But because I’m a very lucky girl, I’ve now landed in a “group,” which is an insurance company creation to make money. If I had been in a “group” earlier, averaging the costs over a large number of people, it would have been much less for premiums. But I was an individual, so no group pricing for me. In the group I’m in it would be less if there were more people. But insurance companies don’t want us to form large groups because they would lose money then.

I want everyone to have good care and the only reason they don’t now is that insurance companies want to get richer. You know what the biggest increase in health care cost has been in the last decade? Administration costs. You know what that means? Hiring people to tell you all the reasons they don’t pay for your claim. Those people you fight with on the phone are the biggest increase in health care costs.

Eight months after surgery I’m still fighting with my insurance company about paying for the appendectomy they did when I was operated on. It’s standard procedure when ovarian cancer is suspected because the appendix is one of the first places to show abnormal cells. Because they couldn’t tell from initial pathology if mine was cancer or not they took out my appendix. My insurance company doesn’t want to pay for it. They, apparently, believe it would make more sense for me to heal from this surgery and then go back for another surgery, with another hospital stay, to have my appendix out at some later date. It cost an additional $401 during this surgery. But, somehow they believe a 2-3 hospital day stay, sedation, etc. later is more logical than to pay $401 now. I’m not medically trained and I don’t pretend to understand much of anything about the system, but I know that’s ridiculous.

I’m not smart enough to know what to do about the health care system. But I know there’s ENOUGH in this country for everyone to have all they need, and that includes medical care. There is enough. Period. Enough. I’m not saying that you or the guy down the street can’t have more than other people – more than enough. That’s fine with me. I just want everyone to have enough. Enough food. Enough housing. Enough schooling. Enough medical care. Enough.

UPDATE: 9/30/2011I’m still paying medical bills, but have some of them paid off now. I no longer have an employer’s health insurance plan so I have some temporary insurance while I hunt for something permanent again. The COBRA plan was more than my mortgage, so that wasn’t an option. I ended up having a second surgery in 2009 but am now feeling fabulous. I am, indeed, very lucky. I still want everyone to be able to say that.

UPDATE: 6/28/2012I have been a “have not” for months. No health insurance company will insure me now because I had an ovarian tumor removed. We never get past that question. The high risk pool I can buy into would cost me $16,000 a year before they would pay anything – not reasonable for me. Today the Supreme Court upheld that the Affordable Health Care Act, dubbed “Obamacare” by detractors, as constitutional. In 2014 I will be able to buy health insurance because companies will no longer be able to pick and choose their customers.